BROADWAY  COM  CORPORATION

19715 E. HARRISON AVE., CITY OF INDUSTRY, CA 91789    

TEL: (909) 839-2511   FAX: (909) 839-2529

 

CREDIT APPLICATION FORM

COMPANY INFORMATION:

 

COMPANY NAME: ____________________________________  CONTACT PERSON: ______________________________________

 

ADDRESS:   ___________________________________________________________________________________________________

                                                                           

TELEPHONE NO. ______________________________________  FAX NO. _______________________________________________

 

FEDERAL TAX ID NO._________________________________  RESELLER PERMIT NO. ___________________________________

 

DATE STARTED: ______________________________________ NO. OF EMPLOYEES: _____________________________________

 

ESTIMATED MONTHLY PURCHASE: _____________________ ANNUAL REVENUES: _____________________________________

   

PRINCIPLE OFFICER OF COMPANY:

 

PRESIDENT:__________________________________________ HOME TELEPHONE NO. ___________________________________

 

S.S. NO. ______________________________________________DRIVER LICENSE NO. ______________________________________

 

HOME ADDRESS:  ______________________________________________________________________________________________

 

BANK INFORMATION:

 

BANK NAME: _________________________________________ACCOUNT OPEN DATE: ___________________________________

 

CHECKING ACCOUNT NO: ______________________________SAVING ACCOUNT NO: ____________________________________

 

CONTACT PERSON: ____________________ TEL NO. _________________________ FAX NO. _______________________________

 

TRADE REFERENCE:

 

(1) COMPANY NAME:__________________________________CONTACT PERSON:________________________________________

 

      TEL _____________________   FAX.______________________   TERMS: ____________  CREDIT LIMIT:   __________________

 

      ADDRESS: __________________________________________________________________________________________________

 

(2) COMPANY NAME:__________________________________CONTACT PERSON: ________________________________________

 

      TEL _____________________   FAX.______________________   TERMS: ____________  CREDIT LIMIT:    __________________

 

      ADDRESS: ___________________________________________________________________________________________________

 

(3) COMPANY NAME:__________________________________CONTACT PERSON: _________________________________________

 

      TEL _____________________   FAX.______________________   TERMS: ____________  CREDIT LIMIT:    __________________

 

      ADDRESS: ___________________________________________________________________________________________________

 

LANDLORD REFERENCE :

 

OWNER NAME:  ______________________________________   CONTACT PERSON: ________________________________________

 

ADDRESS:    _____________________________________________________________________________________________________

 

TEL. NO. _____________________  FAX NO. _______________________  RENTAL FEE: _____________________________________

 

LEASING PERIOD : FROM __________________ TO ________________, WAREHOUSE AREA: _____________SQUARE FT.

I/WE HEREBY APPLY TO BROADWAY COM CORP. TO OBTAINING CREDIT OR RECONFIRMATION OF OUR EXISTING

 ACCOUNT THE UNDERSIGNED GIVES AND GRANTS VENDER PERMISSION TO VERIFY ALL INFORMATION STATED HEREIN.

 I/WE HEREBY AGREE THAT ALL CREDIT GRANTED AND/OR EXTEND SHALL BE REPAID IN TIMELY FASHION.

 

 

 

________________________________________________________________________________________________________________

AUTHORIZED BY ( TYPE / PRINT )        TITLE                                          SIGNATURE                                                   DATE

 

 

 

BANK CREDIT VERIFICATION FORM

 

BROADWAY  COM  CORPORATION

19715 E. HARRISON AVE., CITY OF INDUSTRY, CA 91789

TEL : (909) 839-2511    FAX : (909) 839-2529        

 

(CUSTOMER, PLEASE FILL OUT THE TOP PORTION BELOW FOR BANK TO RELEASE YOUR ACCOUNT REFERENCE. )

 

COMPANY NAME :                                                                                                                                                                 .

 

BANK NAME :                                                                                            ACCT. OFFICER:                                                .

 

BANK ADDRESS:                                                                                                                                                                    .

 

BANK PHONE:                                                . FAX :                                                  . LOAN NO.                                       .

 

CHECKING ACCT No.                                                               SAVING ACCT No.                                                              .

 

IN ORDER TO INDUCE BROADWAY COM CORP. TO EXTEND CREDIT FOR THE PURCHASE OF BROADWAY COM CORP.’S

 PRODUCTS AND FOR OTHER GOODS AND VALUABLE CONSIDERATION.  WE HEREBY CONVEY, GRANT AND TRANSFER

 TO BROADWAY COM CORP. A PURCHASE MONEY SECURITY INTEREST IN THE PRODUCTS AND ALL PROCEEDS

 THEREFROM UNTIL WE  PERFORM ALL OF OUR OBLIGATIONS HEREUNDER.  WE FURTHER AGREE TO PAY ALL

 COLLECTION FEES, REASONABLE ATTORNEY FEES, COURT COSTS, AND OTHER EXPENSES INCURRED BY

 BROADWAY COM CORP. BY SIGNING THIS AGREEMENT.

 I/WE AUTHORIZE THE RELEASE OF CREDIT AND BANKING INFORMATION TO BROADWAY COM CORP.

 

 

 X                                                                                                                                                                                               .

            AUTHORIZED SIGNATURE                  PRINT NAME AND TITLE                                                DATE

 

 

*******************************************************************************************

 

***********FOR BANK USE ONLY---DO NOT WRITE IN THIS SECTION**********

 

ACCOUNT NO :                                                                                                                                                                       .

                                           CHECKING A/C                             SAVINGS A/C                                OTHER

 

OPEN DATE :                                                                 .                                                    .                                                   .

 

CURRENT BALANCE :                                                 .                                                    .                                                   .

 

AVERAGE BALANCE :                                                 .                                                    .                                                   .

 

ACCOUNT RATING :                                                    .                                                    .                                                   .

 

NSFS :             NO,                   YES, How many times                  ,  Date of Last NSF CHECK                                             .       

 

 

COMMENTS :                                                                                                                                                                          .

 

 

X                                                                                                                                                                                                .

           SIGNATURE                                PRINT NAME AND TITLE                                                                  DATE

 

SINCERELY,

 

 Caroline W.

CREDIT DEPARTMENT

**** PLEASE FAX THIS BACK TO US AT   (909) 839-2529 *****  THANK YOU!

 

 

 

 

 

 

 

 

 

 

BROADWAY  COM  CORPORATION

   19715 E. HARRISON AVE., CITY OF INDUSTRY, CA 91789

   TEL: ( 909 ) 839-2511    FAX: ( 909 ) 839-2529

 

 

  RE :   Re-sale / Tax Exemption Certificate

 

 

Dear Accounts Payable Manager:

 

We are in the process of updating all of our Re-Sale / Tax Exemption Certificate. 

Please FAX BACK this letter with the RE-SALE CERTIFICATE FORM below filled out and a copy of

your Seller’s Permit at your earliest possible convenience to: (909) 839-2529  Attn: Accounting Department.

Thank you in advance to your prompt attention to this matter.  We at  BROADWAY COM CORPORATION

look forward to our continuing successful business relationship.

If you have any questions please do not hesitate to call us. 

 

 

FIRM NAME                                                                                                                                             .

 

I  HEREBY  CERTIFY,  

That I hold valid Seller’s Permit No.                                                                                                          .

issued  pursuant to the Sales and Use Tax Law; that I am engaged in the business of selling:

 

                                                                                                                                                                     .

that the tangible personal property described herein which I shall purchase from:

BROADWAY COM CORPORATION

will be resold by me in the form of tangible personal property; PROVIDED, however, that in the event any

of  such property is used for any purpose other than retention, demonstration, or display while holding it

for sale in the regular course of  business, it is understood that I am required by the Sales and Use Tax Law

to report and pay for the tax, measured by the purchase price of such property.

 

 

Description of  property to be purchased:                                                                                                   .

 

                                                                                                                                                                     .

 

Dated:                                                           .   Signature                                                                            .

 

At                                                                  .   By and Title                                                                       .

 

                                                                      .   Phone                                                                                 .

 

address                                                                                                                                                         .